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Breast cancer (BC), is the most common cancer that affects women, and one of the significant causes of mortality among them. Screening and early detection of the disease are encouraged as a means of reducing mortality and enhancing the prognosis. The purpose of the study is to determine the prevalence of Breast Self-Examination (BSE) uptake and to identify the factors that are associated with the BSE uptake among Maldivian women in the Male’ region. The cross-sectional study was carried out over a period of 3 months in the Male’ region, of the Maldives. A total of 600 female citizens aged 20-79 years were selected using stratified random sampling method. Data were collected using an interviewer-administered questionnaire. About 82.70%, 54.80%, and 63.30% of the respondents had heard about BC, breast cancer screening (BCS), and BSE respectively. 50.80% of the respondents had ever performed BSE with only 22.00% performed it regularly. The significant predictors for BSE uptake were: ever heard about BC [OR=2.069, 95% CI(1.081-3.959)], ever heard about BSE [OR=2.342, 95% CI(1.326-4.137)], ever heard about clinical breast examination (CBE) [OR=1.946, 95% CI(1.117-3.390)], knowledge on early detection of BC [OR=1.077, 95% CI(1.011-1.148)], perceptions on the severity of BC [OR=1.062, 95% CI(1.010-1.116)], perceptions on barriers towards BSE [OR=0.900, 95% CI(0.846-0.958)] and self-efficacy [OR=1.112, 95% CI(1.076-1.150)]. The findings indicated that there is a pressing need for continued education and behaviour modification intervention programs using theories and models to increase women’s overall knowledge and awareness of BC and BCS and modify the long-held incorrect beliefs and misconceptions. In particular, the relevant authorities should play a proactive role in raising awareness of BC and promote BCS.

Breast cancer is the most prevalent form of cancer among women. Breast cancer is identified as the second-highest cancer in the Maldives and the most common cancer among females. Early detection and diagnosis of breast cancer facilitate effective treatment and cure. The main objective of the study is to identify the factors that serve as potential predictors for breast cancer screening uptake (CBE and Mammography) among women in the Male’ region. The cross-sectional study was conducted among 600 women aged 20-79 years in the Male’ region. Stratified random sampling was used to select the study sample. Data was collected using an interviewer-administered questionnaire. About 41.40% and 34.40% of the respondents reported ever having a CBE and a mammogram done respectively. Significant predictors for CBE uptake were age [OR=1.045, 95% CI(1.019-1.072)], ever being diagnosed for any breast disease [OR=12.405, 95% CI(4.099-37.541)], having regular medical check-up [OR=2.156, 95% CI(1.301-3.573)], knowledge on early detection of BC [OR=1.108, 95% CI(1.030-1.193)], perceptions on the susceptibility to BC [OR=1.100, 95% CI(1.022-1.184)], perceptions on the benefits of CBE [OR=1.163, 95% CI(1.036-1.306)], perceptions on barriers towards CBE [OR=0.926, 95% CI(0.866-0.991)], self-efficacy [OR=0.960, 95% CI(0.925-0.996)] and ever performed BSE [OR=2.447, 95% CI(1.423-4.209)]. Significant predictors for mammography screening uptake were having regular medical check-up [OR=2.896, 95% CI(1.289-6.503)], benefits of mammography screening [OR=1.131, 95% CI(1.003-1.277)], and ever done CBE [OR=19.135, 95% CI(7.461-49.077)]. Breast cancer screening uptake rates among Maldivian women are found to be low. Focused and well-planned multiple strategies are needed to enhance the health-promoting and preventive behaviours among Maldivian women for better management of breast cancer burden in the country.

Glutathione (GSH) is an anti-inflammatory and antioxidant biomolecule. Polycaprolactone (PCL) nanofiber mesh (NFM) is capable of the attachment and release of biomolecules for prolonged periods and has the potential as a transdermal drug delivery system during wound healing for a diabetic patient. Our earlier study found that high levels of sugar in diabetic male mice were significantly decreased by daily doses of glutathione administered on the mice. Furthermore, oxidative stress found in diabetic male mice led to the total depletion of glutathione levels in the body’s organs (pancreas, spleen, epididymis, and testis). The objective of this study was to attach GSH with PCL NFM for the controlled release of GSH biomolecules for long periods of time from the fiber mesh into a diabetic body. This study produced PCL NFM using an electrospun technique and tested it on mice to evaluate its efficiency as a dermal drug delivery mechanism. This study dissolved GSH (2.5 mg/mL) with phosphate-buffered saline (PBS) and glutaraldehyde (GLU) solution to create GSH-PBS and GSH-GLU complexes. Each complex was used to soak PCL NFM for 24 h and dried to create PCL-GSH-PBS and PCL-GSH-GLU meshes. Fiber morphology, degradation, fibroblast cell proliferation, cytotoxicity, and GSH release activities from each mesh were compared. Fibroblast cell adhesion and cytotoxicity tests found excellent biocompatibility of both GSH-immobilized PCL meshes and no degradation until 20 days of the study period. The disk diffusion method was conducted to test the antibacterial properties of the sample groups. Release tests confirmed that the attachment of GSH with PCL by GSH-GLU complex resulted in a steady release of GSH compared to the fast release of GSH from PCL-GSH-PBS mesh. The disk diffusion test confirmed that PCL-GSH-GLU has antibacterial properties. The above results conclude that GSH-GLU immobilized PCL NFM can be a suitable candidate for a transdermal anti-oxidative and anti-bacterial drug delivery system such as bandage, skin graft for wound healing application in a diabetic patient.

Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomised control study in a single neurosurgery department Participants: 30 patients aged 35-69 years with clinically diagnosed carpal tunnel syndrome Main outcome measures: Primarily - operative duration, bleeding, pain score on day one, requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in hospital and days taken to return to work. Other outcomes include infection, wound status/cosmesis, injury to median nerve, chronic regional pain syndrome and patient satisfaction. Results: 15 patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent for the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusions: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery.

Unilateral hypertrophy of temporalis muscle (isolated type) is extremely rare and only 14 cases have been reported in English literature since 1990. Although no definitive etiology is identified, stress and bruxism are among the many factors are linked to it. Reported patient ages ranged from 7 years to 62 years and most of them are Caucasians. Here we report the first ever case of an Indo-Aryan ethnic patient who presented with painful swelling of the left temporal region. Temporalis muscle biopsy confirmed the diagnosis of isolated unilateral temporalis muscle hypertrophy. This case raises the importance of considering rare diagnoses such as isolated unilateral temporalis muscle hypertrophy despite the inadequate statistical data on ethnicity or geographic location of a condition.

More than 200 different mutations in peripherin-2 (PRPH2) are associated with multiple subtypes of inherited retinal diseases (IRDs), including retinitis pigmentosa and cone or macular diseases. Our goal was to understand how the poorly characterized PRPH2 mutation p.Pro210Arg (P210R) affects visual function and retinal structure as well as gain insight into the mechanism driving the clinical pathology.Eleven patients had clinical assessments including best-corrected visual acuity (BCVA), full field and multifocal electroretinography (ERG), static (spot size V) and kinetic perimetry (Octopus 900), and dark-adapted chromatic (DAC; Medmont; spot size V) perimetry. Images were acquired with the Optos ultra-wide field camera and spectral-domain optical coherence tomography (SD-OCT). Molecular characteristics of the P210R mutant protein were evaluated in vitro.Patients with the P210R mutation had BCVA (Snellen) ranging from 20/15 to 20/80. Perimetry showed a reduction in sensitivity, while ERG findings suggested that cone function was more impaired than rod function. Scotomas were identified corresponding to atrophic retinal lesions. Imaging revealed heterogeneous outer retinal changes such as hyperfluorescent flecks, hypo-autofluorescence (AF) regions of atrophy, and thinning of the photoreceptor layer on SD-OCT. In vitro findings suggested that P210R-Prph2 retains the ability to interact with binding partner Rom1 but abnormally accumulates in the endoplasmic reticulum (ER), suggesting the protein does not fold properly.Rod and cone sensitivities were decreased in subjects with the P210R mutation in PRPH2. There was scotomatous vision loss that occurred within the macula, likely due to atrophy that occurs after drusen have formed and have begun to resolve. This suggests that although rod and cone photoreceptors are dependent on PRPH2, preventing blindness in this specific subgroup of patients could involve therapeutics that impede the formation or lifecycle of drusen.

The incidence of breast cancer in Asian countries is continuously rising, with breast cancer-causing anincrease in mortality among Asian women. The impact of low screening uptake is a matter of concern as inmost cases, cancers have been diagnosed in the advanced stages where medical intervention is not curablebut only intended to improve the quality of care. Therefore, there has been comprehensive advocacy forearly detection and treatment of breast cancer as a strategy to mitigate breast cancer-related morbidityand mortality rates. This paper reviewed existing research on breast cancer screening and the factors thatare associated with breast cancer screening among Asian women. The findings from numerous studiesconducted in Asian countries provides evidence that the number of factors such as socio-demographiccharacteristics, knowledge on breast cancer, including its symptoms and risk factors as well as breastcancer screening modalities, beliefs or perceptions and barriers in terms of structural, psychological,cultural and social factors influences women's adherence to the preventive health promotive behaviour -breast cancer screening. These findings direct to the need for well-planned strategies and intervention thatare culturally sensitive and specifically tailored to the needs of Asian women to successfully promote andadvocate the importance of breast health, early detection of breast cancer and adoption of dynamic routinescreening behaviours.

Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma. All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome. Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorable outcome. GCS score, papillary changes, midline shift and hematoma volume were found to have significant association with the outcome in isolated traumatic acute subdural hematoma. Clinical parameters and radiological parameters can gauge the outcome in isolated traumatic brain injury.

Hemostasis is one of the most essential measures in Neurological procedures. Surgicel (Oxidized cellulose) is one of the most frequently used hemostatic agent used worldwide during surgical procedures. We aim to present a case of radiological diagnostic dilemma of a ring enhancing brain lesion where brain abscess, intracranial hematoma and surgicelloma was identified as challenging differential diagnosis. In this paper, we present a case, where a complication occurred with the use of surgicel following craniectomy and evacuation of hematoma.

Introduction: Carpal Tunnel Syndrome (CTS) is one of the most frequently encountered entrapment neuropathies. It is prevalent in middle age groups. Conservative management is effective in the majority of population surgery being offered to those who don’t respond to medical therapy. Objectives: To compare the efficacy between endoscopic and open carpal tunnel release procedures for carpal tunnel syndrome patients. Design and setting: Randomized control study in a single neurosurgery department. Participants: Thirty patients aged 35-69 years with clinically diagnosed CTS. Main outcome measures: Primarily – operative duration, bleeding, pain score on day one, the requirement of non-steroidal anti-inflammatory drugs (NSAIDs), time spent in the hospital, and days took to return to work. Other outcomes included infection, wound status/cosmesis, injury to the median nerve, chronic regional pain syndrome, and patient satisfaction. Results: Fifteen patients were allocated to open surgery, and the other 15 for endoscopic. The average operative duration for open surgery was 9.9 minutes compared to 52 minutes spent on the endoscopic procedure. Cauterization had to be performed 4:1 times in endoscopic compared to open. Pain scores rated 3x higher after open surgery and resulted in increased NSAIDs use. Time spent in the hospital after open surgery was 0.7 hours compared to 2.2 in endoscopic, however, patients were able to return to work an average of 10.6 days earlier after endoscopic surgery. Conclusion: In carpal tunnel syndrome, endoscopic surgery allowed patients to experience less post-operative pain and return to work several days sooner than in open surgery., Niyaf A, Niraula K, Shareef AS, Mushrif MS. Effectiveness and safety of endoscopic vs open carpal tunnel release: Single center experience from Maldives. Pak J Surg Med. 2020;1(2):113-117. doi: 10.37978/pjsm.v1i2.181

The frequency of adnexal mass in pregnancy ranges from 2% to 10%, dermoid cyst is the most common ovarian germ cell tumor during pregnancy which could be asymptomatic or symptomatic, management through laparoscopy must be considered as it provides several advantages, including reduced postoperative pain, analgesic use, hospitalization time and better cosmetic result. Here we are reporting a case of an unbooked 35 years old primigravida at 16 weeks and 4 days gestation with history of retention of urine. Ultrasound showed a live foetus of 16 weeks gestation with bilateral mild maternal hydroureteronephrosis and complex cystic mass of 13×10 cm in right lumbar region suggestive of ovarian mass. Patient was clinically stable, hence exploratory laparoscopy was taken up the next day. Intraoperatively, dermoid cyst was found in the right ovary. Right ovarian cystectomy was performed. She had an uneventful postoperative period and discharged. She was monitored for the rest of the pregnancy and it was uneventful. She had spontaneous full term normal vaginal delivery of female baby weighing 2.8 kg. Although the patient was clinically stable, large ovarian cyst are predisposed for future complications, hence antenatal diagnosis and appropriate intervention is crucial for good outcome.

Introduction: The recent COVID-19 pandemic has revealed important obstacles in our health care systems, including online specialist consultations. Amidst mass lockdowns and social distancing, we observed the importance of developing a consistent method of performing effective neurological examinations that yield accurate results in a time efficient manner. Objectives: To describe our experience in the Maldives of performing effective online neurological examination. Methodology: We designed and implemented a platform for patients to register for online consultation, collected a comprehensive neurological history, including pictures/scroll-videos of past radiological reports, and guided the patient and their aide through neurological examination methods- both verbally through online video consultation and informative pictorials that depict exactly how-to perform said examinations. Conclusions: Neurological examinations are time consuming, detailed and require skill and expertise to be performed appropriately. Yet, can be customized and adapted to be performed remotely. Proper guidance by examiner and assistance by family or friend with use of pictorials can conclude a thorough online examination.

Central nervous system (CNS) tumors are the most common cause of cancer-related death in children. Little is known about the demographics and treatment of pediatric brain tumors in low- and middle-income countries (LMICs).We performed a retrospective chart review of all pediatric patients who presented to the neurosurgical service at Tribhuvan University Teaching Hospital in Kathmandu, Nepal from 2009-2014 and collected information on patients18 years old who received a diagnosis of a CNS tumor. We analyzed age, gender, clinical presentation, extent of surgical resection, histopathology, and length of hospital stay. We also conducted a literature review using specific terminology to capture studies of pediatric neuro-oncologic epidemiology conducted in LMICs. Study location, length of study, sample size, study type, and occurrence of 4 common pediatric brain tumors were extracted.We identified 39 cases of pediatric CNS tumors, with 62.5% observed in male children. We found that male children (median = 13 years) presented later than female children (median = 8 years). The most frequently observed pediatric brain tumor type was ependymoma (17.5%), followed by astrocytoma (15%) and medulloblastoma (15%). Surgical resection was performed for 80% of cases, and gross total resection reported in 62.9% of all surgeries. More than half (54.1%) of patients had symptoms for more than 28 days before seeking treatment. Symptomatic hydrocephalus was noted in 57.1% of children who presented with CNS tumors. The literature review yielded studies from 18 countries. Study length ranged from 2-20 years, and sample sizes varied from 35-1948. Overall, we found more pronounced variation in the relative frequencies of the most common pediatric brain tumors, compared with high-income countries.We present the first operative series of childhood CNS tumors in Nepal. Children often had delayed diagnosis and treatment of a tumor, despite symptoms. More comprehensive data are required to develop improved treatment and management algorithms in the context of a given country's demographics and medical capabilities for childhood CNS tumors.

Investigated effects of daily injections intra venially (IV) of glutathione (GSH) (11.37 mg/mice)forthe periods 10 and 20 days,for healthy mice and diabetic male micecompared them with control group and diabetic non treated male mice, blood sugar was testedfor fasting mice, induced diabetic, to study the glutathione daily injections e3.ffects on the blood sugar level, total glutathione assay in different body organs and finally study the expression level of the glutathione redox system enzymes glutathione reductase (GR) and glutathione peroxidase (GPx) in pancreas, spleen, testis, and epididymus by the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The experiment outcomes for the glutathione daily injection for the diabetic induced male mice high sugar level significantly decreased. Moreover, the oxidative stress in diabetic male mice leads to depletion of total glutathione level in body organs. Finally, Diabetes causes high oxidative stress in male mice which leads to increase expressions of antioxidants enzymes GR and GPx in pancreas, epididymus and testis.

Introduction: Adhesive intestinal obstruction is an inevitable complication of abdominal surgeries. It has high morbidity with associated poor quality of life and predisposition to repeated hospitalization. Commonest cause of bowel obstruction in developed countries is postoperative adhesions with extrinsic compression of the intestine. Most of them can be managed conservatively. Methods: A retrospective study of 30 patients admitted with the diagnosis of post operative adhesive partial bowel obstruction was conducted by analyzing their medical records. Demographic data, clinical presentation including duration, previous surgical procedures, treatments received for the condition and successful conservative approach versus requirement of operative intervention were assessed. Results: The median age was 31 yrs, most in their third decade of life. Male predominance was noted. Pelvic surgeries and gynecological surgeries (26%) were found to be the most common cause of adhesive bowel obstruction followed by appendectomy (16%). More than two third of the patients (76.7%) developed symptoms within two years of the initial surgery. Successful conservative treatment was noted in 22 patients (73.3%) and discharged on fourth day of admission. Eight patients (26.6%) underwent surgery. They all underwent adhesiolysis and had good outcome. Conclusions: The time-honored practice of expectant management of adhesive partial bowel obstruction has equally good outcome, as compared to various interventions practiced Keywords: Adhesive bowel obstruction; conservative management DOI: http://dx.doi.org/10.3126/joim.v32i2.4939 Journal of Institute of Medicine, August, 2010; 32: 18-20